Family Needs Questionnaire (FNQ)

Abstract

The Family Needs Questionnaire (FNQ) is a widely utilized psychometric instrument designed to assess the specific needs of family members and primary caregivers of individuals who have sustained severe neurological injuries, primarily Traumatic Brain Injury (TBI) or Spinal Cord Injury (SCI). Developed by Kreutzer and Marwitz in 1989, the scale measures the degree to which 37 distinct needs—ranging from informational and professional support to emotional and instrumental support—are met or unmet. The FNQ is crucial for identifying areas where clinical and rehabilitative services need to be enhanced to reduce caregiver burden and improve family adjustment following catastrophic injury. The instrument helps guide family-centered interventions by quantifying needs related to health information, emotional support, and community integration.

Keywords

Family Needs Questionnaire, FNQ, Traumatic Brain Injury, Spinal Cord Injury, Family Needs Assessment, Caregiver Burden, Rehabilitation, Instrumental Support, Emotional Support, Health Information.

Authors

Jeffrey S. Kreutzer, John M. Marwitz, C. Devany, S. Keck, N. Nabors, J. Seacat, M. Rosenthal, M. Meade, L. Taylor, V. Thomas.

Purpose

The primary purpose of the FNQ is to systematically quantify the perceived requirements of family members involved in the long-term care, rehabilitation, or education of a patient with a severe neurological injury. By assessing 37 specific needs, the instrument provides clinicians and researchers with a clear profile of which needs are being successfully addressed and which remain unmet. This information is vital for tailoring rehabilitation interventions and support programs, ensuring that the care plan is holistically focused on both the patient and the family unit.

The scale is particularly useful in acute care and post-acute rehabilitation settings, serving as a basis for family-centered care planning. Its application helps ensure that the psychosocial and practical demands placed upon the family unit are recognized and addressed, thereby mitigating potential conflicts and reducing long-term stress associated with the patient’s recovery trajectory, a key contributor to caregiver burden.

Construct

The FNQ is conceptually grounded in the stress and coping framework, focusing on the psychological and practical demands placed on the family system by a catastrophic injury. It assesses needs across multiple dimensions critical for family functioning and integration into the patient’s care process. Factor analysis has consistently identified several key subscales, representing distinct areas of need that require clinical attention.

The core constructs measured by the FNQ are typically grouped into six distinct factors:

• Need for Health Information (e.g., medical status, prognosis, treatments).
• Need for Professional Support (e.g., respect from staff, honesty, involvement in planning).
• Need for Involvement with Care (e.g., involvement in decision-making, understanding patient behavior).
• Need for Emotional Support (e.g., reassurance, help managing feelings, hope for the future).
• Need for Instrumental Support (e.g., help with household tasks, financial/legal counseling, respite care).
• Need for a Community Support Network (e.g., understanding from friends, employers, or support groups).

Validity

While the initial development focused on content validity—ensuring the items reflected real needs reported by families of TBI patients—subsequent research, notably by Kreutzer, Devany, and Keck (1994), has strongly supported the scale’s construct validity. The resulting six-factor structure aligns theoretically with known areas of stress faced by caregivers following neurological injury, confirming that the scale accurately maps the domain of family needs.

The FNQ has demonstrated criterion validity by correlating significantly with measures of family adjustment and caregiver burden, such as those investigated by Nabors, Seacat, & Rosenthal (2002). Studies consistently confirm that higher levels of unmet needs, as measured by the FNQ, are predictive of increased psychological distress and poorer functional outcomes for the family unit.

Reliability

The FNQ exhibits strong internal consistency, a hallmark of reliable psychometric instruments. Research utilizing the FNQ, including the 1994 analysis, typically reports high Cronbach’s alpha coefficients for the overall scale, often exceeding 0.90, indicating excellent reliability across the total score. The individual subscales also generally show acceptable to strong internal consistency, confirming that items within each factor measure a unified construct.

Test-retest reliability has been established across various time points in the recovery process, suggesting that the measurement of family needs is stable over time, particularly in acute and subacute phases of recovery, provided the patient’s medical status remains relatively consistent. This stability supports its use both as a diagnostic tool and as an outcome measure to track the efficacy of supportive interventions.

Factor Analysis

The original factor analysis performed on the FNQ identified six primary factors utilizing principal components analysis with varimax rotation. These factors account for a significant portion of the variance in family needs following brain injury. The identification of these six factors allows researchers and clinicians to focus on specific domains of need, enabling targeted interventions rather than relying solely on a global score.

The factor structure has proven robust across different patient populations, including those affected by SCI, as demonstrated by Meade et al. (2004). This cross-diagnostic stability underscores the fundamental nature of the assessed needs among families coping with severe, long-term physical and cognitive disabilities, confirming the scale’s broad applicability within Rehabilitation Psychology.

Instrument

Test Type: Self-report questionnaire.

Format: 37 items rated on a three-point scale (“Yes,” “Partly,” or “No”) regarding whether the need has been met.

Language Available: Primarily English (published research suggests translations may exist, but English is the standard academic version).

Population Group: Family members and primary caregivers of patients with neurological or catastrophic injuries.

Age Group: Adults (family members/caregivers).

Population Details: Initially validated on families of individuals with TBI, but widely applicable to families managing chronic or severe disability (e.g., SCI, stroke, other acquired brain injuries).

Test Methodology: Respondents indicate the extent to which each listed need has been met during the caregiving period. Scoring typically involves summing the number of unmet needs (“No” responses) or partially met needs (“Partly” responses), yielding a total unmet need score and six distinct subscale scores.

Keywords

Psychometrics, Neurological Injury, Family-Centered Care, Rehabilitation Psychology, Acute Care, Outcome Measurement, Family Adaptation, Needs Assessment.

Authors

Author ORCID Identifier: Not specified in the source material.

Affiliation Email addresses: Not specified in the source material.

Correspondence Address: Correspondence is often directed to the National Resource Center for Traumatic Brain Injury, Richmond, Virginia (as per 1989 publication).

Permissions & Fee and Test Year

The FNQ was first developed and published in 1989 by Kreutzer and Marwitz at The National Resource Center for Traumatic Brain Injury. The instrument is often available for clinical and research use without significant fees, especially through academic research repositories like the Center for Outcome Measurement in Brain Injury (COMBI).

The instrument is available online via the Center for Outcome Measurement in Brain Injury (COMBI): http://www.tbims.org/combi/fnq/. The original PDF for the study by Meade et al. (2004) concerning acute family needs after Spinal Cord Injury can be downloaded here: Meade et al., 2004 PDF.

Reference’s

• Kreutzer, J., and Marwitz, J. (1989). The Family Needs Questionnaire. Richmond, Virginia: The National Resource Center for Traumatic Brain Injury.
• Kreutzer, J., Devany, C., Keck, S. (1994). Family needs following brain injury: A quantitative analysis. Journal of Head Trauma Rehabilitation, 9(3), 104-115.
• Marwitz, J. (2000). The Family Needs Questionnaire. The Center for Outcome Measurement in Brain Injury. http://www.tbims.org/combi/fnq (accessed November 14, 2017).
• Nabors, N., Seacat, J., & Rosenthal, M. (2002). Predictors of caregiver burden following traumatic brain injury. Brain Injury, 16, 1039-1050.
• Meade, M., Taylor, L., Kreutzer, J., Marwitz, J., & Thomas, V. (2004). A preliminary study of acute family needs after spinal cord injury: Analysis and implications. Rehabilitation Psychology, 49, 150-155.
• Agonis, Julianne. (2012). Family Resiliency, Family Needs And Community Re-Integration In Persons With Brain Injury. Florida Atlantic University, Doctoral dissertation.

Items of the Family Needs Questionnaire (FNQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

I NEED……

1. To be shown that medical, education or rehab. staff respect the patient’s needs or wishes.
2. To be told daily what is being done w/the patient.
3. To give my opinions daily to others involved in patients’ Care, rehabilitation, or education
4. To be told about all changes in the patient’s medical status.
5. To be assured that the best possible medical care is being given to the patient.
6. To have explanations from professionals given in Terms I understand.
7. To have my questions answered honestly.
8. To be shown that my opinions are used in planning the patient’s treatment, rehabilitation or education.
9. To have a professional to turn to for advice or services when The patient needs help.
10. To have complete information on the medical care of traumatic injuries (e.g., medications, injections, or surgery).
11. To have complete information on the patient’s physical problems (e.g., medications, injections, surgery)
12. To have complete information on the patient’s problems in thinking (e.g., confusion, memory, or communication)
13. To have complete information on drug or alcohol problems and treatment.
14. To be told how long each of the patient’s problems are expected to last.
15. To be shown what to do when the patient is upset or acting strange.
16. To have information on the patient’s rehabilitative or educational progress.
17. To have help in deciding how much to let the patient do by himself/herself.
18. To have enough resources for the patient (e.g., rehab. programs, physical therapy, counseling., job counseling)
19. To have enough resources for myself of the family (e.g., financial or legal counseling, respite care, counseling, nursing)
20. To have help keeping house (e.g., shopping, cleaning, cooking)
21. To have help from other members of the family unit in taking care of the patient.
22. To get enough rest or sleep.
23. To get a break from my problems/responsibilities.
24. To spend time with my friends.
25. To pay attention to my own needs, jobs or interests.
26. To have my significant other understand how difficult it is For me.
27. To have my partner or friends understand his/her problems.
28. To have other family members understand the patient’s problems.
29. To have the patient’s friends understand his/her problems.
30. To have the patient’s employer, coworkers or teachers understand his/her problems/
31. To discuss my feelings about the patient with someone who has gone through the same experience.
32. To discuss my feelings about the patient w/other friends/ family.
33. To be reassured that it is usual to have strong feelings about the patient.
34. Help getting over my doubts and fears about the future.
35. Help in remaining hopeful about the patient’s future.
36. Help preparing for the worst.
37. To be encouraged to ask other to help out.

Scoring: Has this need been met? “Yes,” “Partly,” or “No”